Optimum methodology for estimating baseline serum creatinine for the acute kidney injury classification.

This study aimed to investigate how varied methods of determining baseline serum creatinine (SCr) would affect acute kidney injury (AKI) diagnosis and prediction of 60 day mortality in critically ill patients following an episode of AKI. This is a single-centre retrospective study conducted at a tertiary referral hospital. All adult intensive care unit (ICU) patients between January and December 2011, who had at least one SCr values measured between 7 days and 180 days before hospital admission and during ICU stay, were analyzed. The baseline SCr was calculated using either the most recent (SCrmost recent ) or the minimum (SCrmin ) value of SCr measurement over the specified assessment period before hospital admission. AKI was defined based on KDIGO SCr definition. The primary outcome was 60 day mortality after ICU admission. A total of 4020 patients were included in the analysis. AKI was detected in 1204 (30.0%) using the SCrmin and 945 (23.5%) using the SCrmost recent (P < 0.001). Compared with patients without AKI regardless of baseline SCr methodology, the 60 day mortality risk of patients who developed AKI using the SCrmin and SCrmost recent was significantly increased (odds ratio (OR) = 3.74; 95% confidence interval (CI) 2.98-4.70). Similarly, the risk of 60 day mortality in patients who met AKI criteria using the SCrmin but not the SCrmost recent was significant higher than in patients without AKI (OR = 2.04; 95% CI 1.36-3.00). Using the minimum value of preadmission SCr as a baseline kidney function not only can detect more AKI cases, but also provides the better predictive ability for 60 day mortality.

Thongprayoon C ，Cheungpasitporn W ，Kittanamongkolchai W ，Srivali N ，Ungprasert P ，Kashani K ... -  《-》

The impact of fluid balance on diagnosis, staging and prediction of mortality in critically ill patients with acute kidney injury.

Thongprayoon C ，Cheungpasitporn W ，Srivali N ，Ungprasert P ，Kittanamongkolchai W ，Kashani K ... -  《-》

The comparison of the commonly used surrogates for baseline renal function in acute kidney injury diagnosis and staging.

Thongprayoon C ，Cheungpasitporn W ，Harrison AM ，Kittanamongkolchai W ，Ungprasert P ，Srivali N ，Akhoundi A ，Kashani KB ... -  《BMC Nephrology》

Dipstick albuminuria and acute kidney injury recovery in critically ill septic patients.

Acute kidney injury (AKI) is a frequent complication of sepsis, a pro-inflammatory state that alters tubular handling of filtered albumin. We hypothesized that dipstick albuminuria (DA) is associated with a lower rate of AKI recovery in septic patients. This was a single-centre, retrospective cohort study of adults with sepsis-associated AKI in an urban academic intensive care unit (ICU). Patients with unknown baseline serum creatinine (SCr), absent urinalysis, and those with estimated glomerular filtration rate (eGFR) <15 mL/min per 1.73m(2) or receiving chronic renal replacement therapy (RRT) were excluded. The independent variable was DA (negative or trace, 30 mg/dL, and ≥100 mg/dL) within the first 72 h of ICU stay. The outcome variable was AKI recovery at 30 days following hospital discharge, defined as the last SCr returning to a level less than 1.5 times the baseline SCr level and independence of RRT. A total of 988 patients were included in the study. The median length of hospitalization was 11 days. The patients with higher degree of DA had worse critical illness scores. After adjustment for several confounders, DA ≥30 mg/dL was independently associated with "no AKI recovery" at 30 days post-discharge (adjusted OR 1.40, 95% CI, 1.01-1.95 for DA =30 mg/dL and 1.67, 1.15-2.42 for DA ≥100 mg/dL, P = 0.02). Other independent predictors of "no AKI recovery" were cumulative fluid balance, Sequential Organ Failure Assessment (SOFA) score, exposure to diuretics, and the need for mechanical ventilation. Dipstick albuminuria ≥30 mg/dL is independently associated with lower rate of AKI recovery at 30 days post-discharge. Our findings emphasize the potential utility of a simple routine test of DA in the risk-stratification of AKI recovery in ICU septic patients.

Neyra JA ，Li X ，Yessayan L ，Adams-Huet B ，Yee J ，Toto RD ，Acute Kidney Injury in Critical Illness Study Group ... -  《-》

Evaluation of the accuracy of estimated baseline serum creatinine for acute kidney injury diagnosis.

Hatakeyama Y ，Horino T ，Nagata K ，Kataoka H ，Matsumoto T ，Terada Y ，Okuhara Y ... -  《-》